Fatty liver disease (FLD) is being recognized as a silent epidemic for many reasons. One of them is that the disease remains asymptomatic for many years, even decades. The other reason is the growing prevalence. A report suggests that almost a third of the world’s population may be suffering from the disease. Fatty liver is described in the context of alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD) with the pathogenesis of excess fat being different in the two conditions. While increasing alcohol consumption coupled with an unhealthy lifestyle is pushing ALD, NALD is also spiralling upward on the back of what may be termed as a modern lifestyle health crisis.
In India, a report estimates that the prevalence of the disease may be about 9-32%. Obese and diabetic patients are more likely to suffer from NALD. The numbers are likely to go up given the fact that India is the diabetic capital of the world.
Advanced medical science is making considerable progress in treating the condition; however, conventional medications have limited efficacy besides also have notable side effects. Many alternative therapies which are regarded as safe and natural are also being considered, however, the mode of action and composition of the active ingredients are not fully understood.
In more recent times, there has been a lot of study and research directed toward finding the best and most effective pathway to treat liver damage due to FLD. Using Essential Phospholipids (EPL) as a sole therapeutic agent or using them to enhance the bioavailability of existing known nutrients such as silymarin is gaining importance as a research topic.
Phosphatidylcholine – An effective EPL protectant for the liver
All cells in the human body are surrounded by a bilayer of phospholipids which are essential lipids for all biological membranes. Phosphatidylcholine (PC), which is a phospholipid nutrient, is a universal building block of all cell membranes of the body and is the most important support nutrient for the liver. The liver’s ability to renew itself depends mostly on its capacity to make new cell membranes which constitute about 65% of PC. Phosphatidylcholine (PC) is essential for cellular differentiation, proliferation, and regeneration, as well as for the transport of essential molecules through membranes.
Decades of research and clinical trials prove beyond doubt that PC protects the liver from alcoholism-induced damage, and damage caused due to viruses, polluting substance and other toxins. The liver carries out hundreds of complex enzymatic reactions through various metabolic pathways and plays a critical role in maintaining the overall health of the body. Due to the constant exposure of the liver to food-borne toxins and lifestyle induced toxins like alcohol, the protective antioxidants stored in the liver get depleted, the parenchymal cells of the liver die leading to inflammation and necrotic liver conditions.
PC when supplemented in dietary form speeds recovery of the liver. PC is compatible with several pharmaceuticals and other nutrients. It is also shown to be highly bioavailable and acts as a superior emulsifier when combined with other nutrients and thus enhancing the bioavailability of the other nutrients as well.
Benefits of plant-based EPLs in liver therapy
Excessive consumption of alcohol, allergic reactions to drugs, and immunological effects due to virus infections lead to a significant reduction in the PL content of liver cells. Liver functions can be severely impaired due to reduced membrane fluidity, causing liver cirrhosis or fibrosis.
Clinical studies and research indicate that a controlled oral administration of soya derived EPLs helped in reducing hepatotoxic effects in patients with liver damage. A highly purified polyenylphosphatidylcholine (PPC) molecule, an essential phospholipid extracted from soya bean was shown to be beneficial. Its main active ingredient differentiates it from other phospholipids, lecithins, or extracts from other sources.
EPL also has been shown to increase membrane fluidity. Studies have shown that the metabolic functions of the liver significantly improved. Fibrogenic properties were corrected, and immune properties were also improved. Lipid metabolism also showed significant improvement and hepatocyte necrosis was almost abolished.
EPLs when used alone or in combination with other active ingredients (like herbals, vitamins, etc) are indicated as nutritional support in the management of liver fatty degeneration, hepatitis (caused by toxins, medicines, or alcohol abuse), or cirrhosis.
Commercial availability of EPLs
EPLs extracted from lecithin are traditionally used in soft gelatin capsules as a source of essential lipids for hepatoprotection. However, an inferior quality lecithin will be highly viscose, rich in triglycerides and low in essential phospholipids content can overall impact, its solubility and bioavailability to the cell are reduced significantly. To deliver their therapeutic benefits, adequate solubility is often a challenge as it significantly determines the bioavailability of these ingredients in our body. Recent forms of PC though have a lower viscose composition and contain a bioavailable fraction of essential phospholipids. They can be directly encapsulated in soft gel or hard gel capsules. Solubility is a determining step to ensure permeability of any active. The newer forms have superior dissolution properties thus rendering them more permeable. This helps in achieving significantly better therapeutic efficacy and hepato-protection.
Future of EPLs in liver therapy
Several controlled clinical studies confirm those essential phospholipids when administered in a controlled and bioavailable manner lead to successful improvement of specific indicators of liver damage. It also leads to faster functional and structural recovery of liver tissue. Essential phospholipids containing the PC have found usefulness in a dietary supplemental form as well. The PC molecule enhances the bioavailability of nutrients with which it is co-administered. Certain studies provide indirect evidence that dietary phospholipid may protect the development of atherosclerosis, due to beneficial effects on plasma and liver lipid metabolism.
Even though EPL cannot cure chronic liver disease by itself, its membrane-regulating effects slow the progression of the disease. Combining EPL with other liver-active drugs is a potential area of research that can help investigate their respective efficacy, preferably in long-term clinical studies.
